In the course of a case manager’s day, there are certain situations that immediately grab their attention. The young, unfunded, homeless individuals who present to the Emergency Department with bipolar disorder and a history of substance abuse. They may go on to be diagnosed with osteomyelitis, requiring 6 weeks of IV therapy that will make a dramatic impact on the case manager’s day. The mere hint of this type of situation can cause case managers to re-prioritize our already jammed-packed day. However, cringing starts when case managers discover individuals diagnosed with acute kidney injury requiring dialysis treatments on their case load.
That was until recently!
As of January 1, 2017, Medicare started providing coverage and payment to both hospital-based and freestanding dialysis centers for patients diagnosed with acute kidney injury for treatments. Historically, Medicare did not cover such services unless the patient was diagnosed with end stage renal disease. Previously, physicians had 45 days to document the transition to a diagnosis of end stage renal disease from acute kidney injury. The time period also gave the patient’s body the opportunity for kidney recovery. However, during this period of time, Medicare patients did not have coverage to receive ongoing outpatient dialysis treatments due to the lack of a confirmed diagnosis. This meant the patients remained in acute care settings awaiting an appropriate diagnosis or kidney recovery.
This change in Medicare policy gives case managers the ability to facilitate swift and responsible discharge planning services that never existed for this patient population. Patients with acute kidney injury can now return to their prior living arrangements and receive necessary dialysis treatments under Medicare insurance benefits. This is great news for the patients as well as for case managers and the hospitals where they work. Patients can move through the continuum of care to discharge, leaving hospital beds for those who are acutely ill. Resources, including staff efforts and energy, can be utilized to the maximum benefit of those in need. As healthcare should be.